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Hauser RG, Swerdlow CD. What electrophysiologists should know about cardiac implantable electronic device recalls. Heart Rhythm 2024; 21:958-961. [PMID: 38403233 DOI: 10.1016/j.hrthm.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Robert G Hauser
- The Joseph F. Novogratz Family Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | - Charles D Swerdlow
- Smidt Heart Institute at Cedars Sinai Medical Center, Los Angeles, California
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2
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Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes. PATIENT EDUCATION AND COUNSELING 2024; 123:108177. [PMID: 38341898 PMCID: PMC10997451 DOI: 10.1016/j.pec.2024.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT. METHODS Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome. RESULTS Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making. CONCLUSION Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT. PRACTICE IMPLICATIONS Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.
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Affiliation(s)
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI, USA
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | | | - Toby C Campbell
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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3
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Andersson EM, Lindvall K, Wennberg P, Johansson H, Nordin S. From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification. BMC Psychol 2024; 12:47. [PMID: 38268015 PMCID: PMC10809670 DOI: 10.1186/s40359-023-01467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients' reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. METHODS In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants' evaluation of the risk communication was assessed in the intervention group (n = 1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n = 714-857). RESULTS The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification. CONCLUSIONS The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01849575. Registration date 08/05/2013.
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Affiliation(s)
- Elin M Andersson
- Department of Psychology, Umeå University, S-901 87, Umeå, Sweden.
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helene Johansson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, S-901 87, Umeå, Sweden
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4
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Fallon E, Bargary N, Quinn F, Leavy A, Hannigan A. Words and numbers: a comparative study of medical and journalism students' descriptors of risk, numeracy and preferences for health risk communication. BMC MEDICAL EDUCATION 2024; 24:84. [PMID: 38263114 PMCID: PMC10807177 DOI: 10.1186/s12909-024-05048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Given the complementary roles of health professionals and journalists in communicating health risks to patients and the public, there have been calls for physicians to work with journalists to improve the quality of health information received by the public. Understanding the preferences of medical and journalism students for the way in which health risks are communicated and their understanding of words used to describe risk is an important first step to inform interdisciplinary learning. METHODS Medical and journalism students (n = 203) completed an online survey where they were given qualitative descriptors of risk such as 'a chance', 'probably' and 'unlikely', and asked to assign a number that represents what the word means to them. Different formats of communicating risk (percentages, natural frequency and visual aids) were provided and students were asked to select and explain their preference. A thematic analysis of reasons was conducted. Numeracy and perceived mathematics ability were measured. RESULTS Numbers assigned to the descriptor 'A chance' had the highest variability for medical students. Numbers assigned to the descriptor 'Probably' had the highest variability for journalism students. Using visual aids was the most popular format for risk communication for both courses (56% of medical students and 40% of journalism students). Using percentages was twice as popular with journalism students compared to medical students (36% vs. 18%). Perceived mathematics ability was lower in students with a preference for natural frequencies and in journalism students, however performance on an objective numeracy scale was similar for all three formats (percentages, natural frequency and visual aids). Reasons for choosing a preferred format included good communication, eliciting a response, or learning style. CONCLUSIONS Education on health risk communication for medical and journalism students should emphasize the need for qualitative descriptors of risk to be combined with the best available number. Students are already considering their role as future communicators of health risks and open to tailoring the mode of presentation to their audience. Further research is required on the design and evaluation of interdisciplinary workshops in health risk communication for medical and journalism students to maximise the opportunities for future inter-professional working.
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Affiliation(s)
- Eleanor Fallon
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Fergal Quinn
- School of English, Irish and Communication, University of Limerick, Limerick, Ireland
| | - Aisling Leavy
- Department of STEM Education, Mary Immaculate College, Limerick, Ireland
| | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
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5
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Jeffery AD, Reale C, Faiman J, Borkowski V, Beebe R, Matheny ME, Anders S. Inpatient nurses' preferences and decisions with risk information visualization. J Am Med Inform Assoc 2023; 31:61-69. [PMID: 37903375 PMCID: PMC10746300 DOI: 10.1093/jamia/ocad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/10/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE We examined the influence of 4 different risk information formats on inpatient nurses' preferences and decisions with an acute clinical deterioration decision-support system. MATERIALS AND METHODS We conducted a comparative usability evaluation in which participants provided responses to multiple user interface options in a simulated setting. We collected qualitative data using think aloud methods. We collected quantitative data by asking participants which action they would perform after each time point in 3 different patient scenarios. RESULTS More participants (n = 6) preferred the probability format over relative risk ratios (n = 2), absolute differences (n = 2), and number of persons out of 100 (n = 0). Participants liked average lines, having a trend graph to supplement the risk estimate, and consistent colors between trend graphs and possible actions. Participants did not like too much text information or the presence of confidence intervals. From a decision-making perspective, use of the probability format was associated with greater concordance in actions taken by participants compared to the other 3 risk information formats. DISCUSSION By focusing on nurses' preferences and decisions with several risk information display formats and collecting both qualitative and quantitative data, we have provided meaningful insights for the design of clinical decision-support systems containing complex quantitative information. CONCLUSION This study adds to our knowledge of presenting risk information to nurses within clinical decision-support systems. We encourage those developing risk-based systems for inpatient nurses to consider expressing risk in a probability format and include a graph (with average line) to display the patient's recent trends.
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Affiliation(s)
- Alvin D Jeffery
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN 37212, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Janelle Faiman
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Vera Borkowski
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
| | - Russ Beebe
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN 37212, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Shilo Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Center for Research and Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville, TN 37232, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
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Ben-Moshe N, Levinstein BA, Livengood J. Probability and informed consent. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:545-566. [PMID: 37552358 DOI: 10.1007/s11017-023-09636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023]
Abstract
In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues.
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Affiliation(s)
- Nir Ben-Moshe
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA.
| | - Benjamin A Levinstein
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
| | - Jonathan Livengood
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
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Wiens MO, Trawin J, Pillay Y, Nguyen V, Komugisha C, Kenya-Mugisha N, Namala A, Bebell LM, Ansermino JM, Kissoon N, Payne BA, Vidler M, Christoffersen-Deb A, Lavoie PM, Ngonzi J. Prognostic algorithms for post-discharge readmission and mortality among mother-infant dyads: an observational study protocol. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1233323. [PMID: 38455948 PMCID: PMC10911031 DOI: 10.3389/fepid.2023.1233323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/13/2023] [Indexed: 03/09/2024]
Abstract
Introduction In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine follow-up after delivery and facility discharge, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and informing a patient-centered approach to postnatal care interventions. This study aims to derive post-discharge risk prediction algorithms that identify mother-newborn dyads who are at risk of re-admission or death in the first six weeks after delivery at a health facility. Methods This prospective observational study will enroll 7,000 mother-newborn dyads from two regional referral hospitals in southwestern and eastern Uganda. Women and adolescent girls aged 12 and above delivering singletons and twins at the study hospitals will be eligible to participate. Candidate predictor variables will be collected prospectively by research nurses. Outcomes will be captured six weeks following delivery through a follow-up phone call, or an in-person visit if not reachable by phone. Two separate sets of prediction models will be built, one set of models for newborn outcomes and one set for maternal outcomes. Derivation of models will be based on optimization of the area under the receiver operator curve (AUROC) and specificity using an elastic net regression modelling approach. Internal validation will be conducted using 10-fold cross-validation. Our focus will be on the development of parsimonious models (5-10 predictor variables) with high sensitivity (>80%). AUROC, sensitivity, and specificity will be reported for each model, along with positive and negative predictive values. Discussion The current recommendations for routine postnatal care are largely absent of benefit to most mothers and newborns due to poor adherence. Data-driven improvements to postnatal care can facilitate a more patient-centered approach to such care. Increasing digitization of facility care across low-income settings can further facilitate the integration of prediction algorithms as decision support tools for routine care, leading to improved quality and efficiency. Such strategies are urgently required to improve newborn and maternal postnatal outcomes. Clinical trial registration https://clinicaltrials.gov/, identifier (NCT05730387).
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Affiliation(s)
- Matthew O. Wiens
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- WALIMU, Kampala, Uganda
| | - Jessica Trawin
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
| | - Yashodani Pillay
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Vuong Nguyen
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
| | | | | | - Angella Namala
- Department of Obstetrics & Gynaecology, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Lisa M. Bebell
- Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - J. Mark Ansermino
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Kissoon
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Beth A. Payne
- Digital Health Research, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Astrid Christoffersen-Deb
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Digital Health Research, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science & Technology, Mbarara, Uganda
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Yao K, van der Veen T, Thygesen J, Bass N, McQuillin A. Multiple psychiatric polygenic risk scores predict associations between childhood adversity and bipolar disorder. J Affect Disord 2023; 341:137-146. [PMID: 37643680 DOI: 10.1016/j.jad.2023.08.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND It remains unclear how adverse childhood experiences (ACE) and increased genetic risk for bipolar disorder (BD) interact to influence BD symptom outcomes. Here we calculated multiple psychiatric polygenic risk scores (PRS) and used the measures of ACE to understand these gene-environment interactions. METHOD 885 BD subjects were included for analyses. BD, ADHD, MDD and SCZ PRSs were calculated using the PRS-CS-auto method. ACEs were evaluated using the Children Life Event Questionnaire (CLEQ). Participants were divided into groups based on the presence of ACE and the total number of ACEs. The associations between total ACE number, PRSs and their interactions were evaluated using multiple linear and logistic regressions. Secondary analyses were performed to evaluate the influence of ACE and PRS on sub-phenotypes of BD. RESULTS The number of ACEs increased with the ADHD PRS. BD participants who had ACEs showed an earlier age of BD onset and higher odds of having rapid cycling. Increased BD PRS was associated with increased odds of developing psychotic symptoms. Higher ADHD PRS was associated with increased odds of having rapid cycling. No prediction effect was observed from MDD and SCZ PRS. And, we found no significant interaction between ACE numbers and any of the PRSs in predicting any selected BD sub-phenotypes. LIMITATIONS The study was limited by sample size, ACE definition, and cross-sectional data collection method. CONCLUSIONS The findings consolidate the importance of considering multiple psychiatric PRSs in predicting symptom outcomes among BD patients.
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Affiliation(s)
- Kai Yao
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Tracey van der Veen
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Johan Thygesen
- Institute of Health Informatics, University College London, UK
| | - Nick Bass
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK.
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9
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Richter R, Jansen J, Bongaerts I, Damman O, Rademakers J, van der Weijden T. Communication of benefits and harms in shared decision making with patients with limited health literacy: A systematic review of risk communication strategies. PATIENT EDUCATION AND COUNSELING 2023; 116:107944. [PMID: 37619376 DOI: 10.1016/j.pec.2023.107944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Risk communication (RC), as part of shared decision making, is challenging with people with limited health literacy (LHL). We aim to provide an overview of strategies to communicate benefits and harms of diagnostic and treatment options to this group. METHODS We systematically searched PubMed, Embase, Cinahl and PsycInfo. We included 28 studies on RC in informed/shared decision making without restriction to a health setting or condition and using a broad conceptualization of health literacy. Two researchers independently selected studies and one researcher performed data extraction. We descriptively compared findings for people with LHL towards recommendations for RC. RESULTS Health literacy levels varied in the included studies. Most studies used experimental designs, primarily on visual RC. Findings show verbal RC alone should be avoided. Framing of risk information influences risk perception (less risky when positively framed, riskier when negatively framed). Most studies recommended the use of icon arrays. Graph literacy should be considered when using visual RC. CONCLUSIONS The limited available evidence suggests that recommended RC strategies seem mainly to be valid for people with LHL, but more research is required. PRACTICE IMPLICATIONS More qualitative research involving people with LHL is needed to gain further in-depth insights into optimal RC strategies. PROTOCOL REGISTRATION PROSPERO ID 275022.
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Affiliation(s)
- Romy Richter
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Jesse Jansen
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Iris Bongaerts
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Olga Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Jany Rademakers
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands; Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
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10
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Di Minno G, Spadarella G, Maldonato NM, De Lucia N, Castaman G, De Cristofaro R, Santoro C, Peyvandi F, Borrelli A, Lupi A, Follino M, Guerrino G, Morisco F, Di Minno M. Awareness of individual goals, preferences, and priorities of persons with severe congenital haemophilia A for a tailored shared decision-making approach to liver-directed gene therapy. A practical guideline. Blood Rev 2023; 62:101118. [PMID: 37544828 DOI: 10.1016/j.blre.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
In clinical medicine, shared decision making (SDM) is a well-recognized strategy to enhance engagement of both patients and clinicians in medical decisions. The success of liver-directed gene therapy (GT) to transform severe congenital haemophilia A (HA) from an incurable to a curable disease has launched a shift beyond current standards of treatment. However, GT acceptance remains low in the community of HA persons. We argue for both persons with haemophilia (PWH) and specialists in HA care including clinicians, as needing SDM-oriented educational programs devoted to GT. Here, we provide an ad hoc outline to implement education to SDM and tailor clinician information on GT to individual PWHs. Based on routine key components of SDM: patient priorities; recommendations based on individual risk reduction; adverse effects; drug-drug interactions; alternatives to GT; and ongoing re-assessment of the objectives as risk factors (and individual priorities) change, this approach is finalized to exploit efficacious communication.
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Affiliation(s)
| | - Gaia Spadarella
- Dipartimento di Scienze Mediche Traslazionali, Naples, Italy.
| | - Nelson Mauro Maldonato
- Dipartimento di Neuroscienze e di Scienze Riproduttive e Odontostomatologiche, "Federico II" University, Naples, Italy
| | - Natascia De Lucia
- Dipartimento di Neuroscienze e di Scienze Riproduttive e Odontostomatologiche, "Federico II" University, Naples, Italy.
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Florence, Italy.
| | - Raimondo De Cristofaro
- Section of Haemorrhagic and Thrombotic Diseases, Department of Medicine and Translational Surgery, Sacred Heart University, Rome, Italy..
| | - Cristina Santoro
- Ematologia, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy.
| | - Anna Borrelli
- Direzione Sanitaria, AOU "Federico II" Napoli, Italy
| | - Angelo Lupi
- Federazione delle Associazioni Emofilici (FedEmo), Milan, Italy.
| | | | | | | | - Matteo Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Naples, Italy.
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11
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van de Water L, Kuijper S, Henselmans I, van Alphen E, Kooij E, Calff M, Beerepoot L, Buijsen J, Eshuis W, Geijsen E, Havenith S, Heesakkers F, Mook S, Muller K, Post H, Rütten H, Slingerland M, van Voorthuizen T, van Laarhoven H, Smets E. Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial). EClinicalMedicine 2023; 64:102244. [PMID: 37781156 PMCID: PMC10539636 DOI: 10.1016/j.eclinm.2023.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
Background For cancer patients to effectively engage in decision making, they require comprehensive and understandable information regarding treatment options and their associated outcomes. We developed an online prediction tool and supporting communication skills training to assist healthcare providers (HCPs) in this complex task. This study aims to assess the impact of this combined intervention (prediction tool and training) on the communication practices of HCPs when discussing treatment options. Methods We conducted a multicenter intervention trial using a pragmatic stepped wedge design (NCT04232735). Standardized Patient Assessments (simulated consultations) using cases of esophageal and gastric cancer patients, were performed before and after the combined intervention (March 2020 to July 2022). Audio recordings were analyzed using an observational coding scale, rating all utterances of treatment outcome information on the primary outcome-precision of provided outcome information-and on secondary outcomes-such as: personalization, tailoring and use of visualizations. Pre vs. post measurements were compared in order to assess the effect of the intervention. Findings 31 HCPs of 11 different centers in the Netherlands participated. The tool and training significantly affected the precision of the overall communicated treatment outcome information (p = 0.001, median difference 6.93, IQR (-0.32 to 12.44)). In the curative setting, survival information was significantly more precise after the intervention (p = 0.029). In the palliative setting, information about side effects was more precise (p < 0.001). Interpretation A prediction tool and communication skills training for HCPs improves the precision of treatment information on outcomes in simulated consultations. The next step is to examine the effect of such interventions on communication in clinical practice and on patient-reported outcomes. Funding Financial support for this study was provided entirely by a grant from the Dutch Cancer Society (UVA 2014-7000).
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Affiliation(s)
- L.F. van de Water
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - S.C. Kuijper
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - I. Henselmans
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.N. van Alphen
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.S. Kooij
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - M.M. Calff
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - L.V. Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - J. Buijsen
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - W.J. Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - E.D. Geijsen
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - S.H.C. Havenith
- Department of Medical Oncology, Flevoziekenhuis, Almere, the Netherlands
| | - F.F.B.M. Heesakkers
- Department of Surgery, Department of Intensive Care Medicine, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - S. Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K. Muller
- Department of Radiation Oncology, Radiotherapiegroep, Deventer, the Netherlands
| | - H.C. Post
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - H. Rütten
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M. Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - H.W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Saad ED, Coart E, Deltuvaite-Thomas V, Garcia-Barrado L, Burzykowski T, Buyse M. Trial Design for Cancer Immunotherapy: A Methodological Toolkit. Cancers (Basel) 2023; 15:4669. [PMID: 37760636 PMCID: PMC10527464 DOI: 10.3390/cancers15184669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Immunotherapy with checkpoint inhibitors (CPIs) and cell-based products has revolutionized the treatment of various solid tumors and hematologic malignancies. These agents have shown unprecedented response rates and long-term benefits in various settings. These clinical advances have also pointed to the need for new or adapted approaches to trial design and assessment of efficacy and safety, both in the early and late phases of drug development. Some of the conventional statistical methods and endpoints used in other areas of oncology appear to be less appropriate in immuno-oncology. Conversely, other methods and endpoints have emerged as alternatives. In this article, we discuss issues related to trial design in the early and late phases of drug development in immuno-oncology, with a focus on CPIs. For early trials, we review the most salient issues related to dose escalation, use and limitations of tumor response and progression criteria for immunotherapy, the role of duration of response as an endpoint in and of itself, and the need to conduct randomized trials as early as possible in the development of new therapies. For late phases, we discuss the choice of primary endpoints for randomized trials, review the current status of surrogate endpoints, and discuss specific statistical issues related to immunotherapy, including non-proportional hazards in the assessment of time-to-event endpoints, alternatives to the Cox model in these settings, and the method of generalized pairwise comparisons, which can provide a patient-centric assessment of clinical benefit and be used to design randomized trials.
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Affiliation(s)
- Everardo D. Saad
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
| | - Elisabeth Coart
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
| | - Vaiva Deltuvaite-Thomas
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
| | - Leandro Garcia-Barrado
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
| | - Tomasz Burzykowski
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, B-3500 Hasselt, Belgium
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve (IDDI), 1340 Ottignies-Louvain-la-Neuve, Belgium; (E.C.); (V.D.-T.); (L.G.-B.); (T.B.); (M.B.)
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, B-3500 Hasselt, Belgium
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13
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Charu V, Tian L, Kurella Tamura M, Montez-Rath ME. Using Restricted Mean Survival Time to Improve Interpretability of Time-to-Event Data Analysis. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00245. [PMID: 37707829 PMCID: PMC10861099 DOI: 10.2215/cjn.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Vivek Charu
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, VA Palo Alto Health Care Systems, Palo Alto, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
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14
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Borowczyk M, Stalmach-Przygoda A, Doroszewska A, Libura M, Chojnacka-Kuraś M, Małecki Ł, Kowalski Z, Jankowska AK. Developing an effective and comprehensive communication curriculum for undergraduate medical education in Poland - the review and recommendations. BMC MEDICAL EDUCATION 2023; 23:645. [PMID: 37679670 PMCID: PMC10486093 DOI: 10.1186/s12909-023-04533-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND The recognition of the importance of effective communication in the healthcare system has been growing. Given that communication courses must be adjusted to the specificity of a particular culture, language, and other contextual issues, many countries and communities sharing a common language have proposed their recommendations for a communication curriculum for undergraduate medical education. To date, no recommendations have been developed for either any Central and Eastern Europe countries or for regions where Slavic languages are spoken. Their specificity of post-communist transformation should be acknowledged. This study aims to review communication curriculums and offer recommendations for medical communication training for undergraduate medical students in Poland. METHODS The recommendations were developed through an iterative consultation process with lecturers, faculty members of medical schools, and education coordinators. PubMed and Google Scholar databases were searched to identify full text English and Polish language articles on communication curriculum for undergraduate medical education. Additionally, the new Regulation of the Polish Minister of Science and Higher Education, defining educational standards for undergraduate medical education was analysed in search of learning outcomes that could be applied in communication skills teaching. The authors extracted the most relevant communication skill competencies, as determined by the process participants, discussed current challenges, including those of the COVID-19 pandemic era, and indicated best practices. RESULTS A review was conducted, and a set of recommendations was developed pertaining to the scope and methodology of teaching communication skills. The study included: (1) definition, (2) education content, (3) learning outcomes, (4) the recommended teaching methods. The recommendations are in concord with the graduate profile, as well as the current structure of medical studies. The authors listed and discussed the basic communication competencies expected of medical graduates, as well as medical communication course content viewed from different perspectives, including clinical, psychological, sociological, legal, and linguistic. CONCLUSIONS Detailed recommendations aimed at integrating best practices into a comprehensive communication curriculum may promote successful teaching, learning, and assessment of medical communication.
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Affiliation(s)
- Martyna Borowczyk
- Department of Medical Simulation, Poznan University of Medical Sciences, Poznań, Poland
| | - Agata Stalmach-Przygoda
- Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College Kraków, Kraków, Poland
| | - Antonina Doroszewska
- Department of Medical Communication, Medical University of Warsaw, Litewska 16 Street, Warszawa, 00-575, Poland.
| | - Maria Libura
- Department of Medical Education and Simulation of Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Łukasz Małecki
- Department of Medical Education, Center for Innovative Medical Education, Jagiellonian University Medical College Kraków, Kraków, Poland
| | | | - Aldona K Jankowska
- Laboratory for Social Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
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15
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Webb EJD, Meads D, Eskytė I, Ford HL, Bekker HL, Chataway J, Pepper G, Marti J, Okan Y, Pavitt SH, Schmierer K, Manzano A. Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices. THE PATIENT 2023; 16:457-471. [PMID: 37072663 DOI: 10.1007/s40271-023-00622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, UK
| | | | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- The Research Centre for Patient Involvement, Central Denmark Region, Aarhus, Denmark
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
- Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Aureal M, Seauve M, Laplane S, Lega JC, Cabrera N, Coury F. Incidence of infections in patients with psoriatic arthritis and axial spondyloarthritis treated with biological or targeted disease-modifying agents: a systematic review and meta-analysis of randomised controlled trials, open-label studies and observational studies. RMD Open 2023; 9:e003064. [PMID: 37714666 PMCID: PMC10510924 DOI: 10.1136/rmdopen-2023-003064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To estimate the incidence of infections among patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), two distinct phenotypes included in the large group of spondyloarthritis (SpA), treated with tumour necrosis-factor-inhibitors, interleukin-17-inhibitors, Janus kinase-inhibitors, IL-23 or IL-12/23-inhibitors (IL-12/23i), phosphodiesterase 4-inhibitors or cytotoxic T-lymphocyte associated protein 4-Ig. METHODS A meta-analysis of randomised controlled trials (RCTs), open-label extension and observational studies was conducted. Serious infections were defined as infections that were life-threatening, required intravenous antibiotics and/or hospitalisation. Non-serious infections did not meet these severity criteria. The incidence rates (IR) were reported for each diagnosis by treatment class and study type using random-effect model to create a 95% CI. RESULTS Among 23 333 PsA patients and 11 457 axSpA patients, there were 1.09 serious infections per 100 patient-years (PY) (95% CI 0.85 to 1.35) with similar IR in PsA (0.96 per 100 PY 95% CI 0.69 to 1.28) and axSpA (1.09 per 100 PY 95% CI 0.76 to 1.46). The IR was lower in RCTs (0.77 per 100 PY 95% CI 0.41 to 1.20) compared with observational studies (1.68 per 100 PY 95% CI 1.03 to 2.47). In PsA patients, the lowest IR value was observed with IL-12/23i (0.29 per 100 PY 95% CI 0.00 to 1.03). There were 53.0 non-serious infections per 100 PY (95% CI 43.47 to 63.55) in 7257 PsA patients and 5638 axSpA patients. The IR was higher in RCTs (69.95 per 100 PY 95% CI 61.59 to 78.84) compared with observational studies (15.37 per 100 PY 95% CI 5.11 to 30.97). CONCLUSION Serious infections were rare events in RCTs and real-life studies. Non-serious infections were common adverse events, mainly in RCTs. PROSPERO REGISTRATION NUMBER CRD42020196711.
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Affiliation(s)
- Melanie Aureal
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Milene Seauve
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Soline Laplane
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
| | - Jean-Christophe Lega
- Department of Internal and Vascular Medicine, Hospices Civils de Lyon, Lyon, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
| | - Natalia Cabrera
- University of Lyon, Laboratoire de Biométrie et Biologie Évolutive UMR - CNRS 5558, Lyon, France
| | - Fabienne Coury
- Departement of rheumatology, Lyon-Sud Hospital Hospices civiles de Lyon, Pierre-Benite, France
- University of Lyon, University of Lyon 1 Claude Bernard, Lyon, Rhône-Alpes, France
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
- University of Lyon, INSERM UMR 1033, Lyon, France
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Denz R, Timmesfeld N. Visualizing the (Causal) Effect of a Continuous Variable on a Time-To-Event Outcome. Epidemiology 2023; 34:652-660. [PMID: 37462467 PMCID: PMC10392888 DOI: 10.1097/ede.0000000000001630] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Visualization is a key aspect of communicating the results of any study aiming to estimate causal effects. In studies with time-to-event outcomes, the most popular visualization approach is depicting survival curves stratified by the variable of interest. This approach cannot be used when the variable of interest is continuous. Simple workarounds, such as categorizing the continuous covariate and plotting survival curves for each category, can result in misleading depictions of the main effects. Instead, we propose a new graphic, the survival area plot, to directly depict the survival probability over time and as a function of a continuous covariate simultaneously. This plot utilizes g-computation based on a suitable time-to-event model to obtain the relevant estimates. Through the use of g-computation, those estimates can be adjusted for confounding without additional effort, allowing a causal interpretation under the standard causal identifiability assumptions. If those assumptions are not met, the proposed plot may still be used to depict noncausal associations. We illustrate and compare the proposed graphics to simpler alternatives using data from a large German observational study investigating the effect of the Ankle-Brachial Index on survival. To facilitate the usage of these plots, we additionally developed the contsurvplot R-package, which includes all methods discussed in this paper.
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Affiliation(s)
- Robin Denz
- From the Department of Medical Informatics, Biometry, and Epidemiology, Ruhr-University Bochum, Germany
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Abukmail E, Bakhit M, Jones M, Del Mar C, Hoffmann T. Effect of different visual presentations on the public's comprehension of prognostic information using acute and chronic condition scenarios: two online randomised controlled trials. BMJ Open 2023; 13:e067624. [PMID: 37316324 DOI: 10.1136/bmjopen-2022-067624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public. DESIGN Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p<0.016 to allow for three-primary comparisons. PARTICIPANTS AND SETTING Two Australian samples were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed. INTERVENTIONS In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where 'wait and see' is a legitimate option. MAIN OUTCOME Comprehension of information (scored 0-6). SECONDARY OUTCOMES Decision intention, presentation satisfaction and preferences. RESULTS In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI -0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (-0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (-0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (-0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between -1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B). CONCLUSIONS Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).
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Affiliation(s)
- Eman Abukmail
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
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Ferguson M, Shapiro GD, McDonald SD. Understanding and preferences regarding risk communication during pregnancy: a survey to facilitate provider communication with patients. Am J Obstet Gynecol MFM 2023; 5:100929. [PMID: 36931434 DOI: 10.1016/j.ajogmf.2023.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Clear communication of medical risk helps to ensure proper patient understanding of healthcare options and supports informed decision-making. Communication involving visual and written risk typically conveys risk more effectively than conversations alone between a patient and a clinician. However, perception of risk is context-dependent, and the efficacy of and preferences for commonly-used risk communication formats are not well-understood during pregnancy, which is a time of complex decision-making. We sought to address this knowledge gap. OBJECTIVE This study aimed to assess pregnant and recently pregnant people's understanding and preferences for different risk communication formats. STUDY DESIGN We conducted an open online REDCap survey of pregnant and recently pregnant people over a 1-month period in 2022. Study participants were aged 16 to 49 years, pregnant or recently pregnant, and able to provide informed consent in English. Data collected included demographics, measurements of accuracy of understanding including both gist accuracy (general understanding) and verbatim accuracy (numeric quantification), and preferences for risk communication formats including icon arrays, pie charts, bar graphs, and text. Descriptive analyses of the proportion of correctly answered questions were calculated. RESULTS A total of 247 participants completed ≥1 item on accuracy and risk communication preferences, and 230 provided complete responses. Gist (general) understanding was accurate between 74% and 89% of the time for most graphical formats. Verbatim understanding (exact numeric quantification) was approximately 90% accurate for most formats. Respondents preferred that figures be used over circles to display risk in icon arrays, both for themselves and for infants, although figures generated more worry. However, participants substantially preferred pie charts over bar graphs (59%-70% vs 19%-25%). Respondents preferred risk to be expressed with a lower denominator of 200 rather than a higher denominator of 1000 (79% vs 13%, although the lower denominator generated more worry), and in terms of chance of survival rather than chance of death (50% vs 33%). CONCLUSION In a survey of pregnant and recently pregnant people, most respondents preferred pie charts over other graph formats, and lower rather than higher denominators in text. Presentations of survival rather than death estimates were also preferred. Approximately 75% to 90% of respondents accurately understood risk presented with visual and written communication. For the remaining participants, for whom accurate understanding was challenging, new strategies need to be developed.
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Affiliation(s)
- Margot Ferguson
- Faculty of Science, McMaster University, Hamilton, Canada (Ms Ferguson)
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Dr Shapiro)
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada (Dr McDonald).
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Consolandi M. Implicit understandings and trust in the doctor-patient relationship: a philosophy of language analysis of pre-operative evaluations. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:191-208. [PMID: 36780071 DOI: 10.1007/s11017-023-09607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 05/11/2023]
Abstract
The aim of this paper is to enhance doctors' awareness of implicit understandings between doctors and patients in the context of pre-operative communication of risks. This paper draws on insights from the philosophy of language - in particular pragmatic analysis tools - that make explicit the implicit understandings of the interaction. Mastering not only what is said but also what is unsaid allows doctors to improve their communication with their patients. I suggest that being aware of the implications of the interactions is useful for improving both the doctor's and the patient's experience, further strengthening the therapeutic alliance. In this article I analyze actual cases involving pre-operative evaluation before cardiac surgery from a philosophy of language perspective. The paper is structured as follows: a description of the relevant philosophy of language tools that I will apply; an overview of the risk-communication context; an explanation of the link between "the implicit dimension" and trust, addressing whether the doctor needs to convey the whole truth; and the analysis of real cases. In conclusion, I re-emphasize the importance of implicit meanings during risk communication.
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L'Heureux J, McTaggart-Cowan H, Johns G, Chen L, Steiner T, Tocher P, Sun H, Zhang W. How to present work productivity loss results from clinical trials for patients and caregivers? A mixed methods approach. Soc Sci Med 2023; 328:115999. [PMID: 37276772 DOI: 10.1016/j.socscimed.2023.115999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES From the perspectives of patients and caregivers, the objectives were: identifying which result presentations, describing work productivity loss (WPL) outcomes, are most understandable; measuring which presentations are important to report; and investigating which WPL outcomes are viewed as important alongside clinical trials results. METHODS We used a four phased, sequential mixed methods design, guided by patient-oriented research engaging one patient partner. We conducted think-aloud interviews, in British Columbia/Canada, to review WPL results and our survey measuring the understandability and importance of the results, and importance of each WPL outcome. We surveyed a sample representing working Canadians. The findings were summarized and analyzed using linear and logistic regression. We conducted sub-group analyses; one was gender based. All regressions were conducted using generalized estimating equations. RESULTS In our qualitative phases, 20 patients and caregivers were interviewed. Participants recommended for the results to be brief, simple, and represented visually. Then, 118 patients and 120 caregivers were surveyed. The results presented in days or cost yielded the highest understandability and importance to report. All WPL outcomes were identified as important to somewhat important to report by most. The associations indicated that the more understandable the result presentation was, the more likely it was to be rated as important. Age was the only factor significantly associated with selecting days or cost as the most important result. CONCLUSION Presenting WPL results in days and cost, using lay terms and visual supports, were viewed as easiest to understand and most important to report in clinical trials by patients and caregivers. Our findings are supportive of clinical trials standardizing the measurement of WPL to include all of its outcomes (absenteeism, presenteeism, employment status changes and total work productivity loss), in addition to tools assessing the comprehensiveness of WPL results to be provided to patients and caregivers.
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Affiliation(s)
- Jacynthe L'Heureux
- School of Population and Public Health, University of British Columbia; 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Helen McTaggart-Cowan
- Faculty of Health Sciences, Simon Fraser University; Blusson Hall, Room, 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada; British Columbia Cancer Research Centre, 675 W 10th Avenue; Vancouver, British Columbia, V5Z 1L3, Canada.
| | - Gary Johns
- Sauder School of Business, University of British Columbia; 2053 Main Mall, Vancouver, British Columbia, V6T 1Z2, Canada; John Molson School of Business, Concordia University, 1450 Guy Street, Montreal, Quebec, H3H 0A1, Canada.
| | - Lin Chen
- Patient Voices Network, 201-750 Pender Street, Vancouver, British Columbia, V6C 2T8, Canada
| | - Theodore Steiner
- Division of Infectious Diseases, Vancouver General Hospital, 2733 Heather Street, Rm C328 HP East, Vancouver, British Columbia, V5Z 3J5, Canada.
| | - Paige Tocher
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Wei Zhang
- School of Population and Public Health, University of British Columbia; 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia; 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. PATIENT EDUCATION AND COUNSELING 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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23
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Tran T, Ho-Le T, Bliuc D, Abrahamsen B, Hansen L, Vestergaard P, Center JR, Nguyen TV. 'Skeletal Age' for mapping the impact of fracture on mortality. eLife 2023; 12:e83888. [PMID: 37188349 PMCID: PMC10188111 DOI: 10.7554/elife.83888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Background Fragility fracture is associated with an increased risk of mortality, but mortality is not part of doctor-patient communication. Here, we introduce a new concept called 'Skeletal Age' as the age of an individual's skeleton resulting from a fragility fracture to convey the combined risk of fracture and fracture-associated mortality for an individual. Methods We used the Danish National Hospital Discharge Register which includes the whole-country data of 1,667,339 adults in Denmark born on or before January 1, 1950, who were followed up to December 31, 2016 for incident low-trauma fracture and mortality. Skeletal age is defined as the sum of chronological age and the number of years of life lost (YLL) associated with a fracture. Cox's proportional hazards model was employed to determine the hazard of mortality associated with a specific fracture for a given risk profile, and the hazard was then transformed into YLL using the Gompertz law of mortality. Results During the median follow-up period of 16 years, there had been 307,870 fractures and 122,744 post-fracture deaths. A fracture was associated with between 1 and 7 years of life lost, with the loss being greater in men than women. Hip fractures incurred the greatest loss of life years. For instance, a 60-year-old individual with a hip fracture is estimated to have a skeletal age of 66 for men and 65 for women. Skeletal Age was estimated for each age and fracture site stratified by gender. Conclusions We propose 'Skeletal Age' as a new metric to assess the impact of a fragility fracture on an individual's life expectancy. This approach will enhance doctor-patient risk communication about the risks associated with osteoporosis. Funding National Health and Medical Research Council in Australia and Amgen Competitive Grant Program 2019.
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Affiliation(s)
- Thach Tran
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
| | - Thao Ho-Le
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
| | - Dana Bliuc
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
| | - Bo Abrahamsen
- Department of Medicine, Holbæk HospitalHolbækDenmark
- Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern DenmarkOdenseDenmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of OxfordOxfordUnited Kingdom
| | | | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg UniversityAalborgDenmark
- Department of Endocrinology, Aalborg University HospitalAalborgDenmark
- Steno Diabetes Center North JutlandAalborgDenmark
| | - Jacqueline R Center
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
- School of Medicine Sydney, University of Notre Dame AustraliaSydneyAustralia
| | - Tuan V Nguyen
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
- School of Medicine Sydney, University of Notre Dame AustraliaSydneyAustralia
- School of Population Health, UNSW Medicine, UNSW SydneyKensingtonAustralia
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Xu J, Xia C, Ding X. Does health literacy affect older people's avoidance of medical care? The sense of medical care policy alienation and perceptions of control. Geriatr Nurs 2023; 51:202-208. [PMID: 37011492 DOI: 10.1016/j.gerinurse.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
We aimed to clarify whether health literacy (HL) impacts medical care avoidance through an underexplored mediator: a sense of policy alienation towards medical care policy for residents (SPA-M). A moderated mediation model with control perception as a moderator was used to analyze the inner relationship between HL and SPA-M. A cross-sectional survey of 470 people ≥ 60 years old, revealed a significant negative association between HL and medical care avoidance intention, which bootstrapped moderated mediation analysis confirmed is partially mediated by SPA-M. When older people's control perception was high, HL had a significant negative impact on medical care avoidance intention through SPA-M; for low control perception, the effect was insignificant. This study elucidates HL's impact of HL on medical care avoidance, highlighting control perception's relevance to medical care policymaking for older people.
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Gram EG, Jønsson ABR, Brodersen JB, Damhus CS. Questioning 'Informed Choice' in Medical Screening: The Role of Neoliberal Rhetoric, Culture, and Social Context. Healthcare (Basel) 2023; 11:healthcare11091230. [PMID: 37174772 PMCID: PMC10178002 DOI: 10.3390/healthcare11091230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Participation in medical screening programs is presented as a voluntary decision that should be based on an informed choice. An informed choice is often emphasized to rely on three assumptions: (1) the decision-maker has available information about the benefits and harms, (2) the decision-maker can understand and interpret this information, and (3) the decision-maker can relate this information to personal values and preferences. In this article, we empirically challenge the concept of informed choice in the context of medical screening. We use document analysis to analyze and build upon findings and interpretations from previously published articles on participation in screening. We find that citizens do not receive neutral or balanced information about benefits and harms, yet are exposed to manipulative framing effects. The citizens have high expectations about the benefits of screening, and therefore experience cognitive strains when informed about the harm. We demonstrate that decisions about screening participation are informed by neoliberal arguments of personal responsibility and cultural healthism, and thus cannot be regarded as decisions based on individual values and preferences independently of context. We argue that the concept of informed choice serves as a power technology for people to govern themselves and can be considered an implicit verification of biopower.
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Affiliation(s)
- Emma Grundtvig Gram
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Department of People and Technology, Roskilde University, 4000 Roskilde, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - John Brandt Brodersen
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
- Primary Health Care Research Unit, 4100 Region Zealand, Denmark
- The Research Unit for General Practice, Department of Social Medicine, University of Tromsø, 9019 Tromsø, Norway
| | - Christina Sadolin Damhus
- Center of General Practice, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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Hartz SM, Mozersky J, Schindler SE, Linnenbringer E, Wang J, Gordon BA, Raji CA, Moulder KL, West T, Benzinger TL, Cruchaga C, Hassenstab JJ, Bierut LJ, Xiong C, Morris JC. A flexible modeling approach for biomarker-based computation of absolute risk of Alzheimer's disease dementia. Alzheimers Dement 2023; 19:1452-1465. [PMID: 36178120 PMCID: PMC10060442 DOI: 10.1002/alz.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/15/2022] [Accepted: 07/21/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION As Alzheimer's disease (AD) biomarkers rapidly develop, tools are needed that accurately and effectively communicate risk of AD dementia. METHODS We analyzed longitudinal data from >10,000 cognitively unimpaired older adults. Five-year risk of AD dementia was modeled using survival analysis. RESULTS A demographic model was developed and validated on independent data with area under the receiver operating characteristic curve (AUC) for 5-year prediction of AD dementia of 0.79. Clinical and cognitive variables (AUC = 0.79), and apolipoprotein E genotype (AUC = 0.76) were added to the demographic model. We then incorporated the risk computed from the demographic model with hazard ratios computed from independent data for amyloid positron emission tomography status and magnetic resonance imaging hippocampal volume (AUC = 0.84), and for plasma amyloid beta (Aβ)42/Aβ40 (AUC = 0.82). DISCUSSION An adaptive tool was developed and validated to compute absolute risks of AD dementia. This approach allows for improved accuracy and communication of AD risk among cognitively unimpaired older adults.
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Affiliation(s)
- Sarah M. Hartz
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jessica Mozersky
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Junwei Wang
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Brian A. Gordon
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cyrus A. Raji
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Tim West
- C2N Diagnostics, St. Louis, Missouri USA
| | | | - Carlos Cruchaga
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Laura J. Bierut
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chengjie Xiong
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C. Morris
- Washington University School of Medicine, St. Louis, Missouri, USA
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Rosen JE, Agrawal N, Flum DR, Liao JM. Verbal Descriptions of the Probability of Treatment Complications Lead to High Variability in Risk Perceptions: A Survey Study. Ann Surg 2023; 277:e766-e771. [PMID: 35129504 PMCID: PMC9035471 DOI: 10.1097/sla.0000000000005255] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception. BACKGROUND Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making. METHODS A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication. RESULTS Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea. CONCLUSION Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.
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Affiliation(s)
- Joshua E. Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Nidhi Agrawal
- Decision Science Group, University of Washington, Seattle, WA
- Foster School of Business, University of Washington, Seattle, WA
| | - David R. Flum
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Joshua M. Liao
- Decision Science Group, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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Raittio E, Ashraf J, Farmer J, Nascimento GG, Aldossri M. Reporting of absolute and relative risk measures in oral health and cardiovascular events studies: A systematic review. Community Dent Oral Epidemiol 2023; 51:283-291. [PMID: 35238417 DOI: 10.1111/cdoe.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To understand the magnitude of risk of health events, such as cardiovascular diseases (CVD), related to poor oral health, both relative and absolute risk measures should be reported. Our aim was to investigate the extent to which absolute and relative measures of risk are reported in longitudinal studies that assess the association between oral health indicators (OHIs) and CVD. METHODS A systematic search of longitudinal studies investigating the association of any OHI with CVD was carried out using the Embase, Medline and Cochrane library databases. The search covered each database from its inception date to August 2021. Data about reporting relative and absolute risks of the relationship between CVD and OHI from the abstract were extracted. If the relative risk for OHIs and CVD was reported in the abstract, then the underlying absolute risks were searched from the full text, and it was assessed whether it was similarly adjusted for confounding than was the relative risk in the abstract. RESULTS One hundred-six articles were included. From these, 85 (80%) studies reported the association of OHIs and CVD with one or more relative risks in the abstract. Of those 85 studies, the underlying absolute risks were accessible or calculable from the abstract or full text of 60 studies. However, of these 60 studies, in only 10 (12%), the underlying absolute risks were similarly adjusted, as were the relative risks in the abstract. The absolute risks of CVD by OHIs were rarely reported without corresponding relative risks in the abstract (n = 2, 2%). Median absolute risk difference in the CVD risk between exposure levels to which the first relative risk in the abstract referred was 1.8% (interquartile range 0.6-4.6, n = 63). CONCLUSIONS Focusing on relative risks over absolute risks was a common practice in literature. Reporting similarly adjusted underlying absolute risks of relative risks was rare in most studies, despite those being helpful for comprehending the magnitude of CVD-risk increase related to poor oral health. Current reporting practices could lead to an overinterpretation of risk increase of CVD related to poor oral health.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Javed Ashraf
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Julie Farmer
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Gustavo G Nascimento
- Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Musfer Aldossri
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Mitra S, Hatfield T, Campbell-Yeo M, Dorling J, Johnston BC. Evaluation of Health-Related Values and Preferences of Adults Who Were Preterm Infants and Parents of Preterm Infants Concerning Use of Prophylactic Cyclooxygenase Inhibitor Drugs. JAMA Netw Open 2023; 6:e232273. [PMID: 36892840 PMCID: PMC9999240 DOI: 10.1001/jamanetworkopen.2023.2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
IMPORTANCE There is wide variability in the use of prophylactic cyclooxygenase inhibitor (COX-I) drugs to prevent morbidity and mortality in preterm infants. Parents of preterm infants are rarely involved in this decision-making process. OBJECTIVE To explore the health-related values and preferences of adults who were preterm infants and families of preterm infants concerning the prophylactic use of indomethacin, ibuprofen, and acetaminophen initiated within the first 24 hours after birth. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used direct choice experiments conducted in 2 phases of virtual video-conferenced interviews between March 3, 2021, and February 10, 2022: (1) a pilot feasibility study and (2) a formal study of values and preferences, using a predefined convenience sample. Participants included adults born very preterm (gestational age <32 weeks) or parents of very preterm infants currently in the neonatal intensive care unit (NICU) or having graduated from the NICU in the last 5 years. MAIN OUTCOMES AND MEASURES Relative importance of clinical outcomes, willingness to use each of the COX-Is when presented as the only option, preference for using prophylactic hydrocortisone vs indomethacin, willingness to use any of the COX-Is when all 3 options are available, and relative importance of having family values and preferences included in decision-making. RESULTS Of 44 participants enrolled, 40 were included in the formal study (31 parents and 9 adults born preterm). The median gestational age of the participant or the participant's child at birth was 26.0 (IQR, 25.0-28.8) weeks. Death (median score, 100 [IQR, 100-100]) and severe intraventricular hemorrhage (IVH) (median score, 90.0 [IQR, 80.0-100]) were rated as the 2 most critical outcomes. Based on direct choice experiments, most participants were willing to consider prophylactic indomethacin (36 [90.0%]) or ibuprofen (34 [85.0%]), but not acetaminophen (4 [10.0%]) when offered as the only option. Among participants who initially chose indomethacin (n = 36), if prophylactic hydrocortisone was offered as a potential therapy with the caveat that both cannot be used simultaneously, only 12 of 36 (33.3%) preferred to remain with indomethacin. Variability in preference was noted when all 3 COX-I options were available, indomethacin (19 [47.5%]) being the most preferred option followed by ibuprofen (16 [40.0%]), while the remainder opted for no prophylaxis (5 [12.5%]). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study of former preterm infants and parents of preterm infants suggest that there was minimal variability in how participants valued the main outcomes, with death and severe IVH being rated as the 2 most important undesirable outcomes. While indomethacin was the most preferred form of prophylaxis, variability was noted in the choice of COX-I interventions when participants were presented with the benefits and harms of each drug.
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Affiliation(s)
- Souvik Mitra
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal-Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Tara Hatfield
- Division of Neonatal-Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Neonatal-Perinatal Medicine, IWK Health, Halifax, Nova Scotia, Canada
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Neonatology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Bradley C. Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, Texas A&M University, College Station
- Department of Epidemiology, Texas A&M University, College Station
- Department of Biostatistics, Texas A&M University, College Station
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30
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Socha P, Harper S, Hutcheon JA. Subgroup effects should be examined using both relative and absolute effect measures. Aust N Z J Obstet Gynaecol 2023. [PMID: 36859806 DOI: 10.1111/ajo.13656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
Treatment effects can be measured on the relative scale (eg, risk ratios, odds ratios) or the absolute scale (eg, risk differences). If the baseline risk of an outcome is different between subgroups, the effect of the treatment will differ between subgroups on at least one scale (relative, absolute, or both). We illustrate this using two examples from the literature where only relative effects were estimated, but conclusions about subgroup differences would likely have changed had absolute effects also been considered. To identify all meaningful subgroup differences, researchers and clinicians should compare effects on the relative and absolute scale.
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Affiliation(s)
- Peter Socha
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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31
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Denz R, Klaaßen-Mielke R, Timmesfeld N. A comparison of different methods to adjust survival curves for confounders. Stat Med 2023; 42:1461-1479. [PMID: 36748630 DOI: 10.1002/sim.9681] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 11/17/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Treatment specific survival curves are an important tool to illustrate the treatment effect in studies with time-to-event outcomes. In non-randomized studies, unadjusted estimates can lead to biased depictions due to confounding. Multiple methods to adjust survival curves for confounders exist. However, it is currently unclear which method is the most appropriate in which situation. Our goal is to compare forms of inverse probability of treatment weighting, the G-Formula, propensity score matching, empirical likelihood estimation and augmented estimators as well as their pseudo-values based counterparts in different scenarios with a focus on their bias and goodness-of-fit. We provide a short review of all methods and illustrate their usage by contrasting the survival of smokers and non-smokers, using data from the German Epidemiological Trial on Ankle-Brachial-Index. Subsequently, we compare the methods using a Monte-Carlo simulation. We consider scenarios in which correctly or incorrectly specified models for describing the treatment assignment and the time-to-event outcome are used with varying sample sizes. The bias and goodness-of-fit is determined by taking the entire survival curve into account. When used properly, all methods showed no systematic bias in medium to large samples. Cox regression based methods, however, showed systematic bias in small samples. The goodness-of-fit varied greatly between different methods and scenarios. Methods utilizing an outcome model were more efficient than other techniques, while augmented estimators using an additional treatment assignment model were unbiased when either model was correct with a goodness-of-fit comparable to other methods. These "doubly-robust" methods have important advantages in every considered scenario.
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Affiliation(s)
- Robin Denz
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University of Bochum, Bochum, North-Rhine Westphalia, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University of Bochum, Bochum, North-Rhine Westphalia, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University of Bochum, Bochum, North-Rhine Westphalia, Germany
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Usher-Smith JA, Hindmarch S, French DP, Tischkowitz M, Moorthie S, Walter FM, Dennison RA, Stutzin Donoso F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Br J Cancer 2023; 128:1636-1646. [PMID: 36737659 PMCID: PMC9897164 DOI: 10.1038/s41416-023-02145-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.
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Affiliation(s)
- Juliet A. Usher-Smith
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hindmarch
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marc Tischkowitz
- grid.5335.00000000121885934Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Sowmiya Moorthie
- grid.5335.00000000121885934PHG Foundation, University of Cambridge, Cambridge, UK
| | - Fiona M. Walter
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca A. Dennison
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francisca Stutzin Donoso
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Lily Taylor
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- grid.1008.90000 0001 2179 088XCentre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Stephen Morris
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Antonis C. Antoniou
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Fruijtier AD, van der Schaar J, van Maurik IS, Zwan MD, Scheltens P, Bouwman F, Pijnenburg YAL, van Berckel BNM, Ebenau J, van der Flier WM, Smets EMA, Visser LNC. Identifying best practices for disclosure of amyloid imaging results: A randomized controlled trial. Alzheimers Dement 2023; 19:285-295. [PMID: 35366050 PMCID: PMC10084251 DOI: 10.1002/alz.12630] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Empirical studies on effective communication for amyloid disclosure in mild cognitive impairment (MCI) are lacking. We aimed to study the impact of six communication strategies. METHOD We performed a randomized controlled trial with seven randomly assigned, video-vignette conditions: six emphasizing a communication strategy and one basic condition. All showed a scripted consultation of a neurologist disclosing positive amyloid positron emission tomography (PET) scan results to an MCI patient. Healthy individuals (N = 1017; mean age ± SD 64 ± 8, 808 (79%) female) were instructed to imagine themselves in the video, answered questionnaires assessing information recall, emotional state, and behavioral intentions, and evaluate the physician/information. RESULTS "Risk best practice" resulted in highest free recall compared to other strategies (P < .05), except "emotional support". Recall in "emotional support" was better compared to "basic-' and elaborate information"(P < .05). "Risk best practice" resulted in the highest uncertainty (P < .001). "Teach-back" and "emotional support" contributed to the highest evaluations (P -values < .01). CONCLUSION Risk communication best practices, attending to emotions, and teach-back techniques enhance information recall of amyloid-PET results, and could contribute to positive care evaluations.
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Affiliation(s)
- Agnetha D Fruijtier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Medical Psychology, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jetske van der Schaar
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Femke Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jarith Ebenau
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Solna, Sweden
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Wallingford CK, Kovilpillai H, Jacobs C, Turbitt E, Primiero CA, Young MA, Brockman DG, Soyer HP, McInerney-Leo AM, Yanes T. Models of communication for polygenic scores and associated psychosocial and behavioral effects on recipients: A systematic review. Genet Med 2023; 25:1-11. [PMID: 36322150 DOI: 10.1016/j.gim.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to systematically review current models for communicating polygenic scores (PGS) and psycho-behavioral outcomes of receiving PGSs. METHODS Original research on communicating PGSs and reporting on psycho-behavioral outcomes was included. Search terms were applied to 5 databases and were limited by date (2009-2021). RESULTS In total, 28 articles, representing 17 studies in several disease settings were identified. There was limited consistency in PGS communication and evaluation/reporting of outcomes. Most studies (n = 14) presented risk in multiple ways (ie, numerically, verbally, and/or visually). Three studies provided personalized lifestyle advice and additional resources. Only 1 of 17 studies reported using behavior change theory to inform their PGS intervention. A total of 8 studies found no evidence of long-term negative psychosocial effects up to 12 months post result. Of 14 studies reporting on behavior, 9 found at least 1 favorable change after PGS receipt. When stratified by risk, 7 out of 9 studies found high PGS was associated with favorable changes including lifestyle, medication, and screening. Low-risk PGS was not associated with maladaptive behaviors (n = 4). CONCLUSION PGS has the potential to benefit health behavior. High variability among studies emphasizes the need for developing standardized guidelines for communicating PGSs and evaluating psycho-behavioral outcomes. Our findings call for development of best communication practices and evidence-based interventions informed by behavior change theories.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah Kovilpillai
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Clare A Primiero
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia; Dermatology Department, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia.
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Hutcheon JA, Liauw J. Improving the external validity of Antenatal Late Preterm Steroids trial findings. Paediatr Perinat Epidemiol 2023; 37:1-8. [PMID: 34981851 PMCID: PMC9250943 DOI: 10.1111/ppe.12856] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The external validity of randomised trials can be compromised when trial participants differ from real-world populations. In the Antenatal Late Preterm Steroids (ALPS) trial of antenatal corticosteroids at late preterm ages, participants had systematically younger gestational ages than those outside the trial setting. As risk of respiratory morbidity (the primary trial outcome) is higher at younger gestations, absolute benefits of corticosteroids calculated in the trial population may overestimate real-world treatment benefits. OBJECTIVES To estimate the real-world absolute risk reduction and number-needed-to-treat (NNT) for antenatal corticosteroids at late preterm ages, accounting for gestational age differences between the ALPS and real-world populations. METHODS Individual participant data from the ALPS trial (which recruited 2831 women with imminent preterm birth at 34+0 to 36+5 weeks') was appended to population-based data for 15,741 women admitted for delivery between 34+0 and 36+5 weeks' from British Columbia, Canada, 2000-2013. We used logistic regression to calculate inverse odds of sampling weights for each trial participant and re-estimated treatment effects of corticosteroids on neonatal respiratory morbidity in ALPS participants, weighted to reflect the gestational age distribution of the population-based (real-world) sample. RESULTS The real-world absolute risk reduction was estimated to be -2.2 (95% CI -4.6, 0.0) cases of respiratory morbidity per 100, compared with -2.8 (95% CI -5.3, -0.3) in original trial data. Corresponding NNTs were 46 in the real-world setting vs 35 in the trial. Our focus on absolute measures also highlighted that the benefits of antenatal corticosteroids may be meaningfully greater at 34 weeks vs. 36 weeks (e.g., risk reductions of -3.7 vs. -1.2 per 100 respectively). CONCLUSIONS The absolute risk reductions and NNTs associated with antenatal corticosteroid administration at late preterm ages estimated in our study may be more appropriate for patient counselling as they better reflect the anticipated benefits of treatment when used in a real-world situation.
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Affiliation(s)
- Jennifer A Hutcheon
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
| | - Jessica Liauw
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
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36
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Feigin VL, Krishnamurthi R, Merkin A, Nair B, Kravchenko M, Jalili-Moghaddam S. Digital solutions for primary stroke and cardiovascular disease prevention: A mass individual and public health approach. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100511. [PMID: 36605881 PMCID: PMC9808432 DOI: 10.1016/j.lanwpc.2022.100511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
- Institute for Health Metrics Evaluation, University of Washington, Seattle, USA
- Research Centre of Neurology, Moscow, Russia
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Alexander Merkin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Balakrishnan Nair
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | | | - Shabnam Jalili-Moghaddam
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, New Zealand
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Recchia G, Lawrence AC, Freeman AL. Investigating the presentation of uncertainty in an icon array: A randomized trial. PEC INNOVATION 2022; 1:None. [PMID: 36518604 PMCID: PMC9731905 DOI: 10.1016/j.pecinn.2021.100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Clinicians are often advised to use pictographs to communicate risk, but whether they offer benefits when communicating risk imprecision (e.g., 65%-79%) is unknown. PURPOSE To test whether any of three approaches to visualizing imprecision would more effectively communicate breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. METHODS 1,300 UK residents were presented with a genetic report with information about BRCA1-related risks, with random assignment to one of four formats: no visualization (text alone), or a pictograph using shaded icons, a gradient, or arrows marking range endpoints. We also tested pictographs in two layouts. Analysis of variance (ANOVA) and regression was employed. RESULTS There was no effect of format. Participants shown pictographs vs. text alone had better uptake of breast cancer risk messages (p < .05, η 2 = 0.003). Pictographs facilitated memory for the specific amount of risk (p < 0.001, η 2 = 0.019), as did the tabular layout. Individuals not having completed upper secondary education may benefit most. CONCLUSIONS We found weak evidence in favor of using simple pictographs with ranges to communicate BRCA risk (versus text alone), and of the tabular layout. INNOVATION Testing different ways of communicating imprecision within pictographs is a novel and promising line of research.
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Affiliation(s)
- Gabriel Recchia
- Corresponding author at: Centre for Mathematical Sciences, Wilberforce Rd, Cambridge CB3 0WA, UK.
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Bjørkheim S, Sætrevik B. Manipulating risk of infection and appeal to public benefit increase compliance with infection control measures in a hypothetical pandemic scenario. PLoS One 2022; 17:e0274024. [PMID: 36413543 PMCID: PMC9681092 DOI: 10.1371/journal.pone.0274024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
To limit an infectious outbreak, the public must be informed about the infection risk and be motivated to comply with infection control measures. Perceiving a situation as threatening and seeing benefits to complying may be necessary to motivate for compliance. The current study used a preregistered survey experiment with a 2-by-2 between-subject design to investigate if emphasizing high infection risk and appealing to societal benefits impacted intention to comply with infection control measures. The results from a representative Norwegian sample (N = 2533) show that describing a high (as opposed to low) personal risk scenario had a small main effect on compliance. Further, appealing to public (as opposed to self-interested) benefits also had a small main effect. There was no interaction between risk scenario and motivational emphasis. The results suggest that to maximize compliance, information about disease outbreak should emphasize the individual risk of contracting the disease, and could also underline the public value of limiting infection spread. These findings can inform health authorities about the motives underlying compliance with infection control measures during an infectious disease outbreak.
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Affiliation(s)
- Sebastian Bjørkheim
- Department for Psychosocial Science, Operational Psychology Research Group, Faculty of Psychology, University of Bergen, Bergen, Norway
- * E-mail:
| | - Bjørn Sætrevik
- Department for Psychosocial Science, Operational Psychology Research Group, Faculty of Psychology, University of Bergen, Bergen, Norway
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39
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Kim DH, Tatsuoka C, Chen Z, Wright JT, Odden MC, Beddhu S, Bellows BK, Bress A, Carson T, Cushman WC, Johnson KC, Morisky DE, Punzi H, Tamariz L, Yang S, Wei LJ. Intensive Versus Standard Blood Pressure Lowering and Days Free of Cardiovascular Events and Serious Adverse Events: a Post Hoc Analysis of Systolic Blood Pressure Intervention Trial. J Gen Intern Med 2022; 37:3797-3804. [PMID: 35945470 PMCID: PMC9640478 DOI: 10.1007/s11606-022-07753-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/27/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Communication of the benefits and harms of blood pressure lowering strategy is crucial for shared decision-making. OBJECTIVES To quantify the effect of intensive versus standard systolic blood pressure lowering in terms of the number of event-free days DESIGN: Post hoc analysis of the Systolic Blood Pressure Intervention Trial PARTICIPANTS: A total of 9361 adults 50 years or older without diabetes or stroke who had a systolic blood pressure of 130-180 mmHg and elevated cardiovascular risk INTERVENTIONS: Intensive (systolic blood pressure goal <120 mmHg) versus standard blood pressure lowering (<140 mmHg) MAIN MEASURES: Days free of major adverse cardiovascular events (MACE), serious adverse events (SAE), and monitored adverse events (hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, or acute kidney injury) over a median follow-up of 3.33 years KEY RESULTS: The intensive treatment group gained 14.7 more MACE-free days over 4 years (difference, 14.7 [95% confidence interval: 5.1, 24.4] days) than the standard treatment group. The benefit of the intensive treatment varied by cognitive function (normal: difference, 40.7 [13.0, 68.4] days; moderate-to-severe impairment: difference, -15.0 [-56.5, 26.4] days; p-for-interaction=0.009) and self-rated health (excellent: difference, -22.7 [-51.5, 6.1] days; poor: difference, 156.1 [31.1, 281.2] days; p-for-interaction=0.001). The mean overall SAE-free days were not significantly different between the treatments (difference, -14.8 [-35.3, 5.7] days). However, the intensive treatment group had 28.5 fewer monitored adverse event-free days than the standard treatment group (difference, -28.5 [-40.3, -16.7] days), with significant variations by frailty status (non-frail: difference, 38.8 [8.4, 69.2] days; frail: difference, -15.5 [-46.6, 15.7] days) and self-rated health (excellent: difference, -12.9 [-45.5, 19.7] days; poor: difference, 180.6 [72.9, 288.4] days; p-for-interaction <0.001). CONCLUSIONS Over 4 years, intensive systolic blood pressure lowering provides, on average, 14.7 more MACE-free days than standard treatment, without any difference in SAE-free days. Whether this time-based effect summary improves shared decision-making remains to be elucidated. TRIAL REGISTRATION ClinicalTrials.gov Registration: NCT01206062.
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Affiliation(s)
- Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA.
| | - Curtis Tatsuoka
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Zhengyi Chen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson T Wright
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Srinivasan Beddhu
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Adam Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Thaddeus Carson
- Department of Medicine, Medical College of Georgia, Augusta, GA, USA
| | - William C Cushman
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen C Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Leonardo Tamariz
- Division of Population Health and Computational Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Song Yang
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Lee-Jen Wei
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Kamineni A, Doria-Rose VP, Chubak J, Inadomi JM, Corley DA, Haas JS, Kobrin SC, Winer RL, Elston Lafata J, Beaber EF, Yudkin JS, Zheng Y, Skinner CS, Schottinger JE, Ritzwoller DP, Croswell JM, Burnett-Hartman AN. Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines. Ann Intern Med 2022; 175:1582-1590. [PMID: 36162112 PMCID: PMC9903969 DOI: 10.7326/m22-1139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cancer screening should be recommended only when the balance between benefits and harms is favorable. This review evaluated how U.S. cancer screening guidelines reported harms, within and across organ-specific processes to screen for cancer. OBJECTIVE To describe current reporting practices and identify opportunities for improvement. DESIGN Review of guidelines. SETTING United States. PATIENTS Patients eligible for screening for breast, cervical, colorectal, lung, or prostate cancer according to U.S. guidelines. MEASUREMENTS Information was abstracted on reporting of patient-level harms associated with screening, diagnostic follow-up, and treatment. The authors classified harms reporting as not mentioned, conceptual, qualitative, or quantitative and noted whether literature was cited when harms were described. Frequency of harms reporting was summarized by organ type. RESULTS Harms reporting was inconsistent across organ types and at each step of the cancer screening process. Guidelines did not report all harms for any specific organ type or for any category of harm across organ types. The most complete harms reporting was for prostate cancer screening guidelines and the least complete for colorectal cancer screening guidelines. Conceptualization of harms and use of quantitative evidence also differed by organ type. LIMITATIONS This review considers only patient-level harms. The authors did not verify accuracy of harms information presented in the guidelines. CONCLUSION The review identified opportunities for improving conceptualization, assessment, and reporting of screening process-related harms in guidelines. Future work should consider nuances associated with each organ-specific process to screen for cancer, including which harms are most salient and where evidence gaps exist, and explicitly explore how to optimally weigh available evidence in determining net screening benefit. Improved harms reporting could aid informed decision making, ultimately improving cancer screening delivery. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.)
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah (J.M.I.)
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California (D.A.C.)
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.S.H.)
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington (R.L.W.)
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and Henry Ford Health System, Detroit, Michigan (J.E.L.)
| | - Elisabeth F Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.)
| | - Joshua S Yudkin
- University of Texas Health Science Center at Houston, Houston, Texas (J.S.Y.)
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.)
| | - Celette Sugg Skinner
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, and Simmons Comprehensive Cancer Center, Dallas, Texas (C.S.S.)
| | - Joanne E Schottinger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (J.E.S.)
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (D.P.R., A.N.B.)
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
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Schladitz K, Weitzel EC, Löbner M, Soltmann B, Jessen F, Schmitt J, Pfennig A, Riedel-Heller SG, Gühne U. Demands on Health Information and Clinical Practice Guidelines for Patients from the Perspective of Adults with Mental Illness and Family Members: A Qualitative Study with In-Depth Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114262. [PMID: 36361142 PMCID: PMC9659184 DOI: 10.3390/ijerph192114262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 05/21/2023]
Abstract
(1) Background: "Patient health information" promote health literacy. "Patient guidelines" as a sub group reflect the current evidence about illnesses and treatment options adapted to the needs of laypersons. Little is known about factors promoting and hindering their use by people affected by mental illness and their relatives. (2) Methods: Telephone interviews (N = 15; n = 4 adults affected by mental illness, n = 5 relatives, n = 6 both applicable) were conducted according to the Sørensen model of health literacy. Data were recorded, transcribed and content-analyzed following Mayring. (3) Results: Health information is used regularly by individuals affected by mental illness and their relatives, but "patient guidelines" are largely unknown. Yet, there is a great willingness to use them. Main barriers are a lack of statistical knowledge, the complexity of health-related topics and cognitive impairment sometimes accompanying mental illnesses. Target group-oriented adaptation as well as transparent and even-handed presentation of (dis-)advantages of treatment options can increase trust. (4) Conclusions: Health information and guidelines can help affected persons and relatives to make treatment decisions by conveying unbiased, up-to-date knowledge. Target group-specific adaptations should be made for psychiatric illnesses and features specific to mental illnesses compared to physical illnesses should be included. Clinical practice guidelines must be distributed more widely to increase their impact.
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Affiliation(s)
- Katja Schladitz
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-15481
| | - Elena C. Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Bettina Soltmann
- Institute of Clinical Psychology and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01062 Dresden, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Köln, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01069 Dresden, Germany
| | - Andrea Pfennig
- Institute of Clinical Psychology and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01062 Dresden, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, 04103 Leipzig, Germany
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Kuss O, Akbulut C, Schlesinger S, Georgiev A, Kelm M, Roden M, Wolff G. Absolute treatment effects for the primary outcome and all-cause mortality in the cardiovascular outcome trials of new antidiabetic drugs: a meta-analysis of digitalized individual patient data. Acta Diabetol 2022; 59:1349-1359. [PMID: 35879478 PMCID: PMC9402762 DOI: 10.1007/s00592-022-01917-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022]
Abstract
AIMS Treatment effects from the large cardiovascular outcome trials (CVOTs) of new antidiabetic drugs are almost exclusively communicated as hazard ratios, although reporting guidelines recommend to report treatment effects also on an absolute scale, e.g. as numbers needed to treat (NNT). We aimed to analyse NNTs in CVOTs comparing dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, or sodium-glucose cotransporter-2 (SGLT2) inhibitors to placebo. METHODS We digitalized individual time-to-event information for the primary outcome and all-cause mortality from 19 CVOTs that compared DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors to placebo. We estimated Weibull models for each trial and outcome and derived monthly NNTs. NNTs were summarized across all trials and within drug classes by random effects meta-analysis methods. RESULTS Treatment effects in the CVOTs appear smaller if they are reported as NNTs: Overall, 100 (95%-CI: 60, 303) patients have to be treated for 29 months (the median follow-up time across all trials) to avoid a single event of the primary outcome, and 128 (95%-CI: 85, 265) patients have to be treated for 39 months to avoid a single death. NNT time courses are very similar for GLP-1 receptor agonists and SGLT2 inhibitors, whereas treatment effects with DPP-4 inhibitors are smaller. CONCLUSIONS We found that the respective treatment effects look less impressive when communicated on an absolute scale, as numbers needed to treat. For a valid overall picture of the benefit of new antidiabetic drugs, trial authors should also report treatment effects on an absolute scale.
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Affiliation(s)
- Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany.
- Deutsches Diabetes-Zentrum, Institut für Biometrie und Epidemiologie, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
| | - Cihan Akbulut
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Asen Georgiev
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Scherr CL, Lillie H, Ratcliff CL, Krakow M, Liu M, Jensen JD. Are some narratives better than others?: The impact of different narrative forms on adolescents' intentions to text and drive. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2176-2188. [PMID: 35104924 PMCID: PMC9339580 DOI: 10.1111/risa.13878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Psychological reactance theory posits individuals seek to restore freedom when threatened. Communication scholars have hypothesized persuasive messages can constitute threats to freedom. The current study engages questions about the potential for different forms of narratives in public service announcements (PSAs) to trigger freedom threats by examining responses to a PSA campaign that utilized three forms of narrative (celebrity testimonials, peer testimonials, and accident stories) to decrease adolescent texting and driving intentions. Participants (N = 214) watched anti-texting and driving narratives, and completed measures of threat to freedom, anger, negative cognition, and attitudes/intentions toward texting/driving. Compared to celebrity/peer testimonial PSAs, accident stories triggered increased anger and, indirectly, decreased intentions to drive safely. The results also suggest the need for continued examination of the best way to model psychological reactance theory, and the value of further research explicating anger as a mechanism of message effects.
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Affiliation(s)
- Courtney L. Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - Helen Lillie
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | | | - Melinda Krakow
- School of Public Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Miao Liu
- School of Journalism and Communication, Beijing Normal University, Beijing, P.R. China
| | - Jakob D. Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, USA
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Sudharsanan N, Favaretti C, Hachaturyan V, Bärnighausen T, Vandormael A. Effects of side-effect risk framing strategies on COVID-19 vaccine intentions: a randomized controlled trial. eLife 2022; 11:78765. [PMID: 35971757 PMCID: PMC9381035 DOI: 10.7554/elife.78765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 01/02/2023] Open
Abstract
Background: Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. A large literature in the behavioral and communication sciences finds that how risks are framed and presented to individuals affects their judgments of its severity. However, it remains unknown whether such framing changes can affect COVID-19 vaccine behavior and be deployed as policy solutions to reduce hesitancy. Methods: We conducted a pre-registered randomized controlled trial among 8998 participants in the United States and the United Kingdom to examine the effects of different ways of framing and presenting vaccine side-effects on individuals’ willingness to get vaccinated and their perceptions of vaccine safety. Results: Adding a descriptive risk label (‘very low risk’) next to the numerical side-effect and providing a comparison to motor-vehicle mortality increased participants’ willingness to take the COVID-19 vaccine by 3.0 percentage points (p=0.003) and 2.4 percentage points (p=0.049), respectively. These effects were independent and additive and combining both framing strategies increased willingness to receive the vaccine by 6.1 percentage points (p<0.001). Mechanistically, we find evidence that these framing effects operate by increasing individuals’ perceptions of how safe the vaccine is. Conclusions: Low-cost side-effect framing strategies can meaningfully affect vaccine intentions at a population level. Funding: Heidelberg Institute of Global Health. Clinical trial number: German Clinical Trials Registry (#DRKS00025551). Vaccination is one of the main strategies for controlling the COVID-19 pandemic. But vaccination rates have slowed and are below target levels in countries like the United States and the United Kingdom. While there are many causes of vaccine hesitancy, several studies have found that fear of side effects is the one of the most important. Although COVID-19 vaccine side-effects are rare, how the media presents these risks may amplify concerns. Addressing public concerns over vaccine side effects is key to improving the uptake of vaccines and booster doses, which has been even lower than primary vaccine series uptake. Studies show that how risk is presented affects people’s risk perceptions and behavior. To learn more about how COVID-19 vaccine risk framing affects risk perception, Sudharsanan et al. enrolled 8,998 people from the United States and the United Kingdom in an online randomized controlled trial. Participants received information about a hypothetical new COVID-19 vaccine, including its side effect rate, and reported their perception of safety and whether they would take the vaccine. The experiments showed that adding the label “very low risk” when describing vaccine side effect rates increased the number of people who said they would take the vaccine by three percentage points. Comparing the risks of the hypothetical vaccine to the much higher chances of motor vehicle deaths increased an individual’s willingness to take the vaccine by 2.4 percentage points. Combining both framing strategies increased people’s desire to get vaccinated by 6.1 percentage points. Deploying these two strategies in vaccine risk communications may help increase primary and booster vaccinations against COVID-19. A next step would be to measure both vaccination intentions and vaccination rates to confirm these strategies.
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Affiliation(s)
- Nikkil Sudharsanan
- Assistant Professorship of Behavioral Science for Disease Prevention and Health Care,Technical University of Munich, Munich, Germany.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Caterina Favaretti
- Assistant Professorship of Behavioral Science for Disease Prevention and Health Care,Technical University of Munich, Munich, Germany.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Violetta Hachaturyan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Wang J, Eccles H, Nannarone M, Schmitz N, Patten S, Lashewicz B. Does providing personalized depression risk information lead to increased psychological distress and functional impairment? Results from a mixed-methods randomized controlled trial. Psychol Med 2022; 52:2071-2079. [PMID: 33143794 DOI: 10.1017/s0033291720003955] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multivariable risk algorithms (MVRP) predicting the personal risk of depression will form an important component of personalized preventive interventions. However, it is unknown whether providing personalized depression risk will lead to unintended psychological harms. The objectives of this study were to evaluate the impact of providing personalized depression risk on non-specific psychological distress and functional impairment over 12 months. METHODS A mixed-methods randomized controlled trial was conducted in 358 males and 354 females who were at high risk of having a major depressive episode according to sex-specific MVRPs, and who were randomly recruited across Canada. Participants were assessed at baseline, 6 and 12 months. RESULTS Over 93% of participants were interested in knowing their depression risk. The intervention group had a greater reduction in K10 score over 12 months than the control group; complete-case analysis found a significant between-group difference in mean K10 change score (d = 1.17, 95% CI 0.12-2.23) at 12 months. Participants in the intervention group also reported significantly less functional impairment in the domains of home and work/school activities, than did those in the control group. A majority of the qualitative interviewees commented that personalized depression risk information does not have a negative impact on physical and mental health. CONCLUSIONS This study found no evidence that providing personalized depression risk information will lead to worsening psychological distress, functional impairment, and absenteeism. Provision of personalized depression risk information may have positive impacts on non-specific psychological distress and functioning. TRIAL REGISTRATION ClinicalTrials.gov NCT02943876.
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Affiliation(s)
- JianLi Wang
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Heidi Eccles
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Molly Nannarone
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Norbert Schmitz
- Douglas Mental Health Research Institute, McGill University, Montreal, Canada
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
| | - Scott Patten
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Iyer I, Iyer A, Kanthawar P, Khot UN. Assessment of freely available online videos of cardiac electrophysiological procedures from a shared decision-making perspective. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:189-196. [PMID: 36046431 PMCID: PMC9422056 DOI: 10.1016/j.cvdhj.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Physicians recommend electrophysiological (EP) procedures to patients with arrhythmic risk. This involves shared decision-making (SDM). Patients increasingly search for additional information online. Freely available online videos are an attractive source. Objective We assessed freely available online videos for EP procedures from the perspective of SDM to determine if such videos can be shared with patients for SDM. Methods We searched for freely available online videos related to 6 common EP procedures limited to English language and duration between 1 and 10 minutes using Google and Bing. Data collected included date and source of upload, number of hits, and duration. Videos were assessed systematically for understandability, actionability (PEMAT tool), relatability, teamwork, and mention of risk. Results A total of 78 videos met our inclusion criteria, out of 960 video links. Overall inter-rater agreement was moderate to good. Video upload dates spanned 12 years and number of hits ranged from 87 to 594,000. The majority of videos (63%) were produced by health care systems or academic institutions. For all 78 videos the mean total PEMAT tool score was 48.6%. Thirty-five percent of videos showed a patient engaged in a conversation with the physician or a team member; 41% of videos showed other team members. The potential for complications was mentioned in 10%. Conclusion The majority of online, freely available videos for common EP procedures lack features useful for SDM and may not be helpful for sharing with patients from that perspective. It is possible to create high-quality videos that can facilitate SDM.
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Affiliation(s)
- Indiresha Iyer
- Lerner College of Medicine, Cleveland Clinic Akron General, Akron, Ohio
- Address reprint requests and correspondence: Dr Indiresha Iyer, Lerner College of Medicine, Cleveland Clinic Akron General, 224 West Exchange St, Suite 225, Akron, OH 44307.
| | - Amogh Iyer
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Pooja Kanthawar
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Umesh N. Khot
- Regional Cardiovascular Medicine, HVTI, Cleveland Clinic, Cleveland, Ohio
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Zhang D, Zhou Y, Liu J, Zhu L, Wu Q, Pan Y, Zheng Z, Zha Z, Zhang J, Chen Z. Application of patient decision aids in treatment selection of cardiac surgery patients: a scoping review. Heart Lung 2022; 56:76-85. [PMID: 35810676 DOI: 10.1016/j.hrtlng.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The choice of treatment is an unavoidable challenge faced in the day to day medical decision making pertaining to patients with organic heart disease. As a professional discipline, cardiac surgery focuses on creating and using the most advanced evidence-based patient decision aids (PtDAs) to achieve high-quality decision-making. OBJECTIVES To describe the basic situation, influencing factors, and the outcome of indicators of PtDAs among cardiac surgery patients. METHODS Seven electronic databases were systematically searched for relevant reviews on the application of PtDAs among cardiac surgery patients. The methodological framework proposed by Arskey and O'Malley was used to guide the scoping review. The extracted data was analyzed qualitatively and quantitatively. RESULTS After dual, blinded screening of titles and abstracts, 12 articles were included in the review. 10 were quantitative studies, 1 was a mixed study, 1 was a qualitative study. CONCLUSIONS Compared with the burden of heart disease and the huge evidence base, the application of PtDAs in cardiac surgery is obviously insufficient. The published literature mainly provide information about the factors to be solved from the perspective of researchers, and also summarize obstacle factors. This is the basis for the application and construction of PtDAs in cardiac surgery patients.
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Affiliation(s)
- Duo Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanrong Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Juan Liu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lisi Zhu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiansheng Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youmin Pan
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhi Zheng
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengbiao Zha
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Zhang
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zelin Chen
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zegarek M, Brienza R, Quinn N. Twelve Tips for teaching shared decision making. MEDICAL TEACHER 2022; 45:1-7. [PMID: 35793200 DOI: 10.1080/0142159x.2022.2093700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Shared decision making (SDM) is a process in which preference-sensitive decisions are discussed with patients in a collaborative and accessible format so that patients can select an option that integrates their values and preferences into the context of evidence-based medicine. While SDM has been shown to improve some metrics of quality of care and is now included in many competencies developed by accreditation bodies, it can be challenging to successfully incorporate competencies in SDM into clinical teaching. Multiple interventions and curricula that build competency in SDM have been published, but here we aim to suggest ways to integrate teaching competencies in SDM into all forms of clinical teaching. These twelve tips provide strategies to foster trainee development of the relational and risk-benefit communication competencies that are required for successful shared decision making.
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Affiliation(s)
- Matthew Zegarek
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Rebecca Brienza
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Noel Quinn
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
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Raza F, Neuberger J. Consent in organ transplantation: putting legal obligations and guidelines into practice. BMC Med Ethics 2022; 23:69. [PMID: 35790956 PMCID: PMC9255499 DOI: 10.1186/s12910-022-00791-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Consent in medical practice is a process riddled with layers of complexities. To some extent, this is inevitable given that different medical conditions raise different sets of issues for doctors and patients. Informed consent and risk assessment are highly significant public health issues that have become even more prominent during the course of the Covid-19 pandemic. In this article we identity relevant factors for clinicians to consider when ensuring consent for solid organ transplantation. Consent to undergo solid organ transplantation is more complex than most surgical and other clinical interventions because of the many factors involved, the complexity of the options and the need to balance competing risks. We first out the context in which consent is given by the patient. We then outline the legal principles pertaining to consent in medical practice as it applies in the UK and the implication of recent legal judgments. The third section highlights specific complexities of consent in organ transplantation and identifies relevant factors in determining consent for organ transplantation. The fourth section offers practical recommendations. We propose a novel 'multi-factor approach' to informed consent in transplantation which includes understanding risk, effective communication, and robust review processes. Whilst understanding risk and communication are a given, our suggestion is that including review processes into the consent process is essential. By this we specifically mean identifying and creating room for discretion in decision-making to better ensure that informed consent is given in practice. Discretion implies that health care professionals use their judgement to use the legal judgements as guidance rather than prescriptive. Discretion is further defined by identifying the relevant options and scope of clinical and personal factors in specified transplantation decisions. In particular, we also highlight the need to pay attention to the institutional dimension in the consent process. To that end, our recommendations identify a gap in the current approaches to consent. The identification of areas of discretion in decision-making processes is essential for determining when patients need to be involved. In other words, clinicians and healthcare professionals need to consider carefully when there is room for direction and where there is little or no room for exercising discretion. In sum, our proposed approach is a modest contribution to the on-going debate about consent in medicine.
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Affiliation(s)
- Farrah Raza
- Pembroke College, University of Oxford, St. Aldates, Oxford, OX1 1DW, UK. .,Max Planck Institute for Social Anthropology, Advokatenweg 36, 06114, Halle, Germany.
| | - James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
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50
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Hamblen JL, Grubbs KM, Cole B, Schnurr PP, Harik JM. "Will it work for me?" Developing patient-friendly graphical displays of posttraumatic stress disorder treatment effectiveness. J Trauma Stress 2022; 35:999-1010. [PMID: 35261090 DOI: 10.1002/jts.22808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/09/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
The goal of this study was to create simple visual displays to help patients understand the benefits of evidence-based treatment for posttraumatic stress disorder (PTSD). We reviewed randomized trials of the most effective individual, trauma-focused psychotherapies and first-line antidepressants for adults with PTSD. The analytic sample included 65 treatment arms from 41 trials. We used binomial logistic regression to estimate the proportion of participants who lost their PTSD diagnosis at posttreatment and created a sample icon array to display these estimates. We provide a range of estimates (0-100) based on varying the percentage of the sample with a military affiliation. The percentage of participants who no longer met the diagnostic criteria for PTSD among civilian populations was 64.3% for trauma-focused treatment, 56.9% for SSRI/SNRI, and 16.7% for waitlist/minimal attention. For military populations, the proportions of participants who no longer met the diagnostic criteria were 44.2%, 36.7%, and 8.1%, respectively. We present icon arrays for 0%, 7%, 50%, and 100% military affiliation displaying 100 icons, a portion of which were shaded to indicate the number of participants that no longer met the PTSD criteria following treatment. After evidence-based treatment, between one third and two thirds of participants no longer met the PTSD criteria. Providers can use the icon array developed in this study with patients to facilitate communication regarding PTSD treatment effectiveness.
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Affiliation(s)
- Jessica L Hamblen
- National Center for PTSD-Executive Division, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen M Grubbs
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Veterans Medical Research Foundation, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Bernard Cole
- Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont, USA
| | - Paula P Schnurr
- National Center for PTSD-Executive Division, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Juliette M Harik
- National Center for PTSD-Executive Division, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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